COVID-19 대응을 위해 한시적으로 허용된 전화상담∙처방 효과 분석

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코로나19전화상담∙처방비대면의료표적집단면접건강보험청구자료COVID-19Telephone consultationTelemedicineFocus Group InterviewHealth Insurance claims data
As of February 24th, 2020, telephone consultation has been temporarily allowed in order to respond COVID-19 pandemic. This was the first time to allow the teleconsultation using telephone between patients and doctors, and patients and doctors came to experience a telemedicine despite of its temporary adoption during the COVID-19.
This study was conducted to explore the current status of the telephone consultation and to examine its effects on providers and users. For doing it, we first conducted a focus group interview(FGI) and individual in-depth interview (IID) with healthcare providers and users on experiences and acceptance to teleconsultation. Secondly, we performed a comprehensive literature review on issues regarding telemedicine – efficacy(effectiveness), cost-effectiveness, patient’s experiences, and implementation. Lastly, we analyzed the healthcare insurance claims data to examine whether treatment patterns were different between teleconsultations and in-person consultations.
The study found 7,031 healthcare providers offered telephone consultation services, 421,053 patients used at least one telephone consultation service and 561,906 telephone consultation encounters were made during the study period of February 24th to June 30th, 2020. The most frequent diagnoses for telephone consultation were high blood pressure, type 2 diabetes, acute bronchitis. The utilization trend of telephone consultation has been with intensity of COVID-19 spread-out and greater in COVID-19 affected areas. We did not find a significant difference in treatment patterns between telephone consultations and in-person consultations. For acute respiratory tract infections, there were no difference in the composition of diagnosis, the number of items prescribed and the rate of antibiotic prescription between telephone consultations and in-person consultations. Days of supply for prescriptions were increased in both telephone consultation and in-person consultation during COVID-19 pandemic, however, the telephone consultation had more increase in days of supply than its counterpart. This is an inconsistent finding with the one from interviews that healthcare providers said to reduce the days of supply in case of teleconsultations for a safety purpose, which requires further analysis and monitoring.
There was a significant gap in acceptance to and satisfaction with telephone consultations between healthcare providers and users. Healthcare service users showed relatively high satisfaction and acceptance to them because of lowering the risk of infections from a direct contact and the convenience. They favored the continuous implementation of telephone consultation even after COVID-19 ends. The high acceptance by patients were internationally found as well. On the other hand, healthcare providers presented low acceptance to telephone consultations in general, raising concerns on safety and effectiveness. However, it is worthy of note that healthcare providers with a sort of guideline provided at the organization level for telephone consultations on type of patients, clear procedure of reservations and check-in, days of supply for prescription, receipt of prescriptions, presented higher acceptance to telephone consultations than those without it.
The study showed that several considerations should be made for the teleconsultation program to guarantee access to cares in effective and safe ways. First, the teleconsultation program needs to be systemized with a clear guideline on the situation and scope. It is also important to streamline procedures for provision of teleconsultations. Adoption of telecommunication technologies enabling visual explanations and observation should be considered as a telephone is the most limited mode of delivering telecommunications. Last but not least, monitoring and evaluation on telecommunications should be implemented to improve patient safety and quality of care.
Alternative Title
The Study on effects of telephone consultations by telephone that is temporarily allowed to response to COVID-19 pandemic
Table Of Contents
요 약 ----------------------------- ⅰ

제1장 서론 ----------------------------- 1
1. 연구 배경 ----------------------------- 1
가. 코로나19 감염 확산 대응을 위한 전화상담·처방의 한시적 허용 ----------------------------- 1
나. 비대면의료 필요성과 쟁점 공존 ----------------------------- 2
다. 비대면의료 용어, 정의 및 종류 ----------------------------- 3
2. 연구 필요성 및 중요성 ----------------------------- 6
3. 연구 목적 ----------------------------- 7
4. 연구 내용 및 방법 ----------------------------- 7

제2장 전화상담·처방의 한시적 허용 및 쟁점 인식 ----------------------------- 9
1. 전화상담·처방의 한시적 허용 ----------------------------- 9
가. 시행 배경 ----------------------------- 9
나. 제도 현황 ----------------------------- 11
2. 쟁점 및 우려 ----------------------------- 14

제3장 국내․외 문헌 고찰 ----------------------------- 17
1. 제외국 비대면의료 현황 ----------------------------- 17
가. 미국 ----------------------------- 17
나. 일본 ----------------------------- 28
다. 호주 ----------------------------- 33
라. 영국 ----------------------------- 41
마. 프랑스 ----------------------------- 45
바. 캐나다 ----------------------------- 51
2. OECD 국가의 비대면의료 현황 및 추세 ----------------------------- 59
가. 비대면의료 관련 규제, 정책 및 재원 조달 ----------------------------- 59
나. 비대면의료 사용에 대한 제한 ----------------------------- 60
다. 비대면의료 사용 추세 및 사용량 ----------------------------- 62
라. 비대면의료 사용 분야 ----------------------------- 63
3. 비대면의료 쟁점 ----------------------------- 66
가. 비대면의료 유효성(효과성), 비용효과성, 환자 경험, 환자 안전 위험 요인 ----------------------------- 66
나. 비대면의료와 대면의료 간의 상호작용 ----------------------------- 81
다. 비대면의료 실행 관련 이슈 ----------------------------- 82
4. 소결 ----------------------------- 92

제4장 전화상담·처방 현황 및 영향 분석 ----------------------------- 95
1. 분석개요 ----------------------------- 95
2. 전화상담·처방 현황 분석 ----------------------------- 96
가. 분석방법 ----------------------------- 96
나. 분석결과 ----------------------------- 98
3. 전화상담·처방 주요 질환군 분석 ----------------------------- 115
가. 만성질환(고혈압, 당뇨병) ----------------------------- 115
나. 호흡기계 ----------------------------- 120
4. 전화상담·처방 주요 환자군 추적 분석 ----------------------------- 125
가. 분석방법 ----------------------------- 125
나. 분석결과 ----------------------------- 126
5. 소결 ----------------------------- 128

제5장 전화상담·처방 만족도 조사 ----------------------------- 131
1. 조사개요 ----------------------------- 131
가. 의료공급자 ----------------------------- 131
나. 의료이용자 ----------------------------- 135
2. 조사결과 ----------------------------- 138
가. 의료공급자 ----------------------------- 138
나. 의료이용자 ----------------------------- 171
3. 소결 ----------------------------- 180

제6장 결론, 제언 및 한계점 ----------------------------- 183
1. 결론 ----------------------------- 183
2. 제언 ----------------------------- 186
가. 전화상담․처방 제도 ----------------------------- 186
나. 비대면의료 제도 ----------------------------- 187
3. 한계점 ----------------------------- 189

참고문헌 ----------------------------- 191

ABSTRACT ----------------------------- 213
김지애 et al. (202012). COVID-19 대응을 위해 한시적으로 허용된 전화상담∙처방 효과 분석.
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